Collateral damage of the Queen’s funeral: The unethical effects of a snap bank holiday

By David Shaw.

The Queen’s funeral took place on 19th September 2022, which was declared a bank holiday. As a result, many NHS services were scaled back: hospital appointments were cancelled, operations were delayed, and GP surgeries closed, with several serious effects on patient care.

Many NHS trusts cancelled non-emergency operations on the day of the funeral, with the result that hundreds of thousands of patients had appointments delayed, possibly for months. Royal Free NHS Trust stated that “the trust will be pausing most of our services. However emergency and urgent care for high priority patients will go ahead as planned. Most out-patient appointments will be postponed.” Similarly, Imperial NHS Trust “decided on balance it is best to postpone much of the planned care that was due to take place”, but stated that it would continue to deliver “time-critical” care. The criteria that led to the assessment that this was the “best” course of action were not revealed.

The impact of these delays on patient care and patient’s wellbeing should not be underestimated. Even prior to the funeral, NHS England already faced the biggest backlog in its history, with almost 6.8 million people on waiting lists for diagnostic tests, care and beds in July 2022. Following the funeral, that figure is likely to have grown to well over 7 million. And several hundred thousand patients have already been waiting for more than a year to be seen. In these circumstances, more and more care becomes “time-critical” or “high priority”. Normally, an operation to remove a tumour would not be treated as an emergency, but if it has already been delayed twice because of Covid and is delayed again because of a funeral, the patient is likely to die sooner as a result.

Other patients will have to wait longer for appointments because of the knock-on effect of having to accommodate all the funeral-day patients later in the year. In addition, waiting for diagnosis or treatment is a stressful process, so even if clinical outcomes are not worsened, hundreds of thousands of patients will experience unnecessary and avoidable psychological harm.  Also, most trusts advised patients to “act as if” their appointment was going ahead, and not to contact hospitals. This creates substantial uncertainty: even patients whose care was not delayed will have been worried that it might be delayed, causing unnecessary stress.

In addition to widespread disruption of hospital NHS services, most GP practices in England closed for the day of the funeral. This may be less disruptive than cancelled operations, but can still delay initial diagnosis and subsequent treatment. Of course, all patients not seen on the day of the funeral will have to wait many days or weeks for a replacement appointment, exacerbating stress for them and those working in practices. It was already anticipated that more patients would seek care from GPs during the period around the Queen’s death, and even one day’s closure makes that situation a lot worse.. Some GP surgeries recognised the harmful effects of closure, and stayed open; however, they received no extra funding for doing so. Dozens of trainee doctors also had exams delayed till next year “out of respect”, meaning that it will be longer before they are qualified to help reduce NHS waiting lists.

The potential collateral damage from the royal funeral is not limited to the NHS. Many food banks closed on the day of the funeral, potentially cutting off essential supplies to struggling families. All schools closed, meaning that children living in poverty were denied their only nutritious meal of the day. Some parents had to take time off work at short notice to provide childcare, with potential loss of salary in the midst of a cost-of-living crisis. The announcement of the government’s plan to tackle the energy crisis was also delayed, and the cancellation of events for the funeral also increased the risk of recession.

What makes all these bad effects even worse is that they were avoidable; the NHS could have kept operating as usual across the country, as was the case in many health board areas, particularly in Scotland. It might be argued that it is standard procedure for fewer NHS and other services to be provided on a bank holiday. That is true, but this was very short notice for a bank holiday, and cancellations are not normally needed because much less care is planned for normal bank holidays.

But more importantly, the Queen’s funeral could have gone ahead without a bank holiday. Had the government and new King not made this decision, hundreds of thousands of patients would have attended their appointments, received their diagnoses, and had their operations. Instead, it was apparently decided that showing the ‘proper’ respect for one dead monarch was worth increasing the risk of harm for many tens of thousands of citizens. Or perhaps the potential disruption simply wasn’t considered at all. As one patient put it, “I’m sure if the Queen knew what was happening she wouldn’t have let it happen. It’s totally unnecessary.”

 

Author: David Shaw

Affiliations: Care and Public Health Research Institute, Maastricht University; Institute for Biomedical Ethics, University of Basel.

Competing interests: None declared

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